Lupus Research Update –

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Discussing the recent article: Incomplete Systemic Lupus Erythematosus: What Remains After Application of American College of Rheumatology and Systemic Lupus International Collaborating Clinics Criteria?

Dr. Ailda Nika shared this article wtih readers. Check lupusil.org for more “Latest News” for the lupus community.

Discussing the recent article: Incomplete Systemic Lupus Erythematosus: What Remains After Application of American College of Rheumatology and Systemic Lupus International Collaborating Clinics Criteria? By Wietske M. Lambers, Johanna Westra, Marcel F. Jonkman, Hendrika Bootsma, and Karina de Leeuw

While we are all forced to deal with the unprecedented times of a new pandemic, the lupus community continues to remain strong and supportive, as research and literature continues to emerge to new levels of hope both therapeutically and understanding the pathophysiology of lupus.

A recent article by Weitske M. Lambers and others, in Arthritis Care and Research published in May, 2020 sheds light into Incomplete Systemic Lupus Erythematosus (iSLE), an acknowledged condition of patients with clinical signs of lupus who do not fulfill American College of Rheumatology classification criteria for SLE.

The aim of the study was to discern the proportion of iSLE patients at higher risk who would benefit from early treatment and intervention. While some patients with iSLE remain mild through their clinical course, up to 55% may progress to established lupus diagnoses.

While there is no substitute for the judgment of an experienced clinician, there is specific criteria a patient has to fulfill in research settings to be classified as lupus.

There have been other different names for patients who do have autoimmune laboratory and clinical signs and symptoms that do not fall into a specific category, such as undifferentiated connective tissue disorder, but for patients with specific lupus symptoms, such as skin for instance, that would not be exactly the appropriate terminology.

The authors propose that the most appropriate name would be incomplete lupus (iSLE) that would include stable mild and more specific disease still not classifiable as SLE.

Multiple studies were reviewed about the future of these patients.

Most patients (up to 46%) would have skin involvement and (53% at early stages) arthritis. On the other hand, a number of these patients might have even more serious involvement such as kidney abnormalities (up to 27%).

Studies have looked at the rate of the progression from iSLE to lupus diagnosis which ranges from as low as 2% to up to 57% in 5 years in one study.

In summary clinical symptoms severity and rate of progression are highly variable and close monitoring and follow up with an experienced clinician are key to provide appropriate level of care for patients with iSLE.

In another study published in the same journal, Arthritis Care and Research, in May of 2019 by Ernest Maningding and others titled the Racial and Ethnic Differences in regard to time and the rate of lupus development was reported from a Californian Lupus Surveillance Project.

The study showed that African Americans, Asian/ Pacific Islanders and Hispanics had higher rate of kidney injury from lupus. African American patients with lupus also, have higher likelihood of neurological complications and both African Americans and Asians higher complications including different aspects of blood abnormalities. All these groups had higher levels of kidney involvement as well, specifically within the first year of diagnoses.

The conclusion is that relative to white patients, racial ethnic minorities may develop more aggressive disease and might require even more specific attention to their circumstances including genetic factors as well as socioeconomic status.

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